This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Tuesday, 7 July 2009

Seething

Had a great day at work. Yeah right. We were supposed to have three Registered nurses and a kid on duty for the shift. Not enough for a large medical ward. Not enough by any means. Every single patient is due medications at the same time, first thing in the morning.

If only one RN does a medication round it would take about 3 hours to get everyone their 8Am drugs. So we split the ward and each RN takes a side. It then takes about 1.5 hours for all the patients to get a quick initial assessment by an RN and hopefully they will get their 8AM drugs by 9:30 or 10:00. That sucks but it is better than sharing the ward and having one RN running around trying to do all the meds.

By the time you finish your drug round you are locked into your side for various reasons.

The third RN was going to do charge and work with the kid doing basic care. It would probably take them until noon or so to get everyone up and washed etc. The other 2 RN's who are locked into their sides get hammered with orders, phone calls, information overload, labs, treatments, assessments etc.

So it sucks but I was looking forward to having 3 RN's rather than just the usual 2 RN's and 2 kids/care assistants.

Then I got to work.

Another ward was short and we were ordered some non nursing manager to send our third RN to work there. Fuck. We cannot only have 2 RN's and 1 kid for the whole ward. Please don't do this I said. I had visions of listening to screaming relatives tell me things I already know for the next 8 hours. I had visions of not having any kind of support in an emergency.

"We need your RN to go to ward 1 as they only have one RN for the day. But, I will send you their care assistant, then you will have 4 of you. If you struggle make the housekeeper work as a nurse" says the manager. Keep in mind that this is a large acute medical ward of well over 20 beds. And we were getting 2 RN's and 2 untrained.

Having only 2 RN's and 2 untrained really blows for a large acute medical ward but this was the deal I was getting. I reluctantly agreed. Really I had no choice in the matter. My RN left to go upstairs and the other ward's care assistant came.

She did not speak a word of English. She had no experience nor training. She had been in the country two weeks (found that out later). She was only scheduled to work half a shift and she was getting passed off as a proper care assistant. Of course no one told me this. I found out a few hours later. I would ask her to do things and get the reply "Yes, Sister" and a lovely smile. She was lovely. But she had no idea what we were telling her to do. And she didn't communicate that with us either. We were under the impression that she was an experienced care assistant. When she first came on the ward I did ask her about her credentials and tell her to tell me if she needed help. I showed her around the ward and explained the routine. She smiled and nodded. I realised something was up after I realised she hadn't checked the blood sugars (hours after I realised they should have been checked, hours after I told her to do them). I won't tell you about the rest of the fuck ups........

Then she left. She was only scheduled half a shift. Neither her nor the manager who took away my RN and sent this girl bothered to mention that she was only on half a shift. That left us with 3 staff for 20 something patients. 2 RN's and a kid.

The kid is actually very good. But she is very limited in what she can do obviously. Really she can only do basic care. But most of patients need 2 staff to be moved in the bed, cleaned, turned, and transferred...so Kid was basically fucked whilst the two RN's got slammed with admits, IV's, orders, phone calls from everyone and his brother etc.

Yes that is right. They took away my RN, sent me an untrained non English speaking non nurse person who was scheduled to leave in the middle of the shift, and then sent admissions.

And guess what. The patient's referred to the foreign woman as "that foreign nurse". Nurse.

And they complained about the fact that we didn't go around with a trolley hot drinks for everyone. If we have enough staff this is usually done by a care assistant or a free nurse at the end of the shift. The kid who was working with me had a choice between getting observations on all 20 something patients when they were due or handing out tea and coffee. There was no way she could do both. She made the right call. The other RN and I were on our knees with all the other things. And the patients complained about the Nurses being to miserable to hand out tea and coffee.

I cannot wait until the next time I see that fucking manager. He is going to wish he was never born. I really needed that 3rd RN as well as about 10 others. I cannot tell the complaining patients like it is so I am going to take it all out on the manager personally.

This is how they screw and screw medical/elderly wards and their staff day after day.

I am so sick of getting shafted like this and then having patients say to me in a condescending and patronising manner "Don't you think the patients would enjoy a nice hot drink". They say it as if they are talking to a 5 year old who just did something really naughty. And they say it while I am running to turn off a heparin drip because of blood results.

No asshole, I never ever realised in all my years of nursing professionally that patients might enjoy a cup of coffee. The thought never ever entered my mind. I guess Im just not caring enough. Idiots.

I will tell you something about the nurses on the official care of the elderly ward at my hospital.

Their ward manager is the only one who is helps them to have a family friendly rota. She is the only one.

My ward sucks. My childcare bills have been through the roof because of it. If I was smart I would have gone to the care of the elderly ward when my kids were little. She would have allowed me to work around my husband and work some kind of set pattern.

A lot of young mothers with young children work on our care of the elderly ward for that reason. Especially if they have husbands who work long hours and cannot drop off/ pick kids up when mummy has to stay at work until 10PM.

Your tutor was a dick. The care of the elderly wards are not the only wards that are full of elderly medical patients. I have also heard of other instances of ward managers on elderly wards bending over backwards to get staff. Many hospital nurses are desperate for family friendly hours.

Funny enough when I last interviewed for a job in the USA ( we nearly got transferred with my husbands job 6 months ago) the only unit at the hospital that was letting nurses work around childcare arrangements was the transitional care unit....in other words it was elderly/rehab.

Did you get the latest from adignifiedrevolution.co.uk - about how NURSES arent taking care of elderly patients again... - they have got their heads so far up their arses...here was my email response:Once again your article is blaming nurses for alleged poor standards of care when the problem is the staffing levels, availability of trained nurses per shift, no thought to staffing for acuity of patients and patient needs, and the use of cadets or untrained aides on the wards who are very limited in their abilities. Nurses are not miracle workers able to meet all patient needs when totally overwhelmed by the work load and unreal expectations by non nurse managers and finance people trying to save money. The modern matrons are apparently invisible and disinterested in fighting for adequate staffing levels or improved care. I havent heard anything good about them. So what was the point of them - wasnt that exactly what they were supposed to do???I have met very few nurses in my time (30yrs in 3 countries) who are lazy or disinterested in providing quality care to all their patients. WE would LOVE to care for and comfort patients, make them clean and comfortable, clean their glasses, feed them, give them drinks, and make beds etc, etc, etc. We have NO problem with any of that!!! I just think you are barking up the wrong tree. Why do you never evaluate staffing levels and take a realtime look at what the situation actually is on a daily basis?? Why arent you grilling management on why the staffing is so poor? Have you any idea how much time it takes to actually care for a bedbound elderly sick person - then multiply that by 12 or more and add in everything else nurses are expected to do along with it. If nurses had no more than 5-6 patients per shift - it would be do-able. If these managers are there to manage the NHS then they need to be accountable for providing adequate nurse staffing and support to enable the nurses to be able to provide the appropriate care as discussed in your article. If they do not do that then what is the point of having them??? They are the ones who silence nurses by threatening them with disciplinary action and being unsupportive and having unreal expectations and not caring as they arent the ones having to struggle through the day looking after so many patients. One nurse who did blow the whistle in desperation after being ignored by her NHS managers - got struck off - so thats where that gets you - great message sent re: importance of patient care huh??Nurses are assigned (eg) 12 or more sick sick sick patients on a heavy medical floor - they all have multiple needs/meds/IVs/etc. The nurses are also expected to answer the phones, supervise aides, deal with visitors, admit/discharge patients and do doctor rounds, all documentation etc etc etc. The managers try to justify the inadequate RN staffing levels by providing these cadets and aides who are very limited in abilities and scope. They are actually the ones supposed to be doing the bedbaths and personal care and feeding and toileting that seems to be the big issue in your article. The nurses get blamed for the fact that they took those duties from registered nurses and gave them to untrained staff. Well look at the result! Pressure sores, dehydration, lying in soiled beds etc. Surely ward cleanliness comes under management/housekeeping - so they should be managing that and cleaning beds in between patients - but no... lets blame it all on nurses again. Yes, the nurses should be doing this and this and this - why arent they doing it? Why are people left in bathrooms and not getting commodes or personal care taken care of? I will guarantee its not because the nurses are slacking off polishing their nails or on extended breaks - they will be trying to do 15 things at once somewhere because the RN STAFFING LEVELS ARE INADEQUATE to provide this ideal of care you keep harping on about. Why not make your next article about that. You can call it - Lets Not Blame the Nurses For Once.

"HELP ONE PERSON AT A TIME, AND ALWAYS START WITH THE PERSON NEAREST TO YOU".........MOTHER TERESA

i gave up and went to icu. I know my patients are not going to survive,we torture them to death in here. i just do it for the salary. stay where you are, or go to a private hospital. the most important persons are your husband and children. old people are old, let them die and with dignity and peace and comfort and in warm dry beds. so what if they didnt get their BIPAP or their i.V. DRUGS......or their fucking simvastatin. xxxxxxxxxxxx god bless you: i know its heart breaking. you describe it SO well i can almost hear the bloody ward phone!!!

Dianne makes a good point. Unless you work in paediatrics or maternity you will be dealing with care of the elderly. Although I did hear from an old friend of mine who works in post natal (mums and babies post birth) in a midwest US hospital that they were forced to take elderly from nursing homes with MRSA on their unit at one point!!

It's the same problem in all developed countries. There are more dependent elderly people that what the system can afford or cope with. There families don't want to care for them but want them kept alive forever.

Yes. Dignity Revolution is insane. I haven't finished with them yet.

My husband didn't get his last bid for transfer but there will be others. We have moved a lot up until now. But due to his job we have to stay put where we are at the minute. May very well get transferred to the west coast, USA in the future. This is what keeps me going. If he gets it we are GONE.

The area we were looking at last time had many many large hospitals and nursing facilities. The possibilities were endless. If you are unhappy at one hospital you can just get a job down the road at one of the many others. So many different specialties as well. I jumped the gun and was looking into hospitals long before my husband's bid for the job was confirmed. I know it won't be prefect but it has to be better than this.

She didn't say that cancer only affects elderly people. She said that you cannot avoid elderly patients all together unless you go to Paeds or OB. It's true. We have a gynae ward that mostly takes young women...the nurses who work there want to look after younger people. And younger/middle aged women makes up most of their patient population.

Until the medical wards get full. Then the gynae ward gets completely full of elderly patients with dementia and sepsis. And man do those nurses get pissed off when that happens. They flat out cannot deal with it.

Then all the gynae patients (like women less than 22 weeks with hyperemesis, ectopics etc) are sent all over the freaking hospital. Maternity won't have them if they are under 20 weeks. The medical wards are full of elderly. The surgical wards are full of elderly. The urology and gynae wards are full of elderly. The nursing homes take 8 weeks to come and assess people, so these elderly patients are delayed discharges. They go from medically stable to extremely ill whilst waiting weeks and weeks for services to go into place so that they can be discharged. Then the whole process has to start again.

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In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.